Laryngoscope insertion section

ABSTRACT

A laryngoscope insertion section comprising a tube guide comprising at least an inferior tube guiding member and a superior tube guiding member, wherein the thickness of the insertion section in a first region is less than the external diameter of the largest diameter endotracheal tube in an operating range of endotracheal tube sizes plus the thickness of the inferior tube guiding member plus the thickness of the superior tube guiding member. Typically, the insertion section comprises an elongate member and the tube guide is lateral of the elongate member. Typically, an endotracheal tube is retained within the tube guide in flexural tension.

FIELD OF THE INVENTION

The invention relates to the field of laryngoscope insertion sectionswhich include a tube guide for detachably retaining an endotracheal tubeand guiding a retained endotracheal tube towards a patient's larynx.

BACKGROUND TO THE INVENTION

Laryngoscopes comprise insertion sections, which are the elongate partof a laryngoscope which extends towards and into a patient's oral cavityduring intubation. Insertion sections may be removably attachable to alaryngoscope body, integral parts of laryngoscopes or themselvesfunction as laryngoscopes. As well as an insertion section,laryngoscopes typically comprises a handle which is usually elongate andwhich may be arranged at an angle to the proximal end of the insertionsection or generally parallel to the proximal end of the insertionsection, or at any angle therebetween.

Some known laryngoscope insertion sections, such as Miller or Wisconsininsertion sections, are substantially flat. However, the insertionsection of a laryngoscope is more commonly bent to better enter througha patient's oropharynx towards their larynx. Some known insertionsections include first and second straight portions, with a bendtherebetween, or are curved, at least in part. Within this specificationand the appended claims, the inferior surface is the surface of aninsertion section which faces the patient's tongue in use. The oppositesurface is referred to as the superior surface. Words such as inferior,inferiorly, superior and superiorly are used in corresponding senses. Asuperior-inferior axis is a virtual axis extending parallel to thesuperior and inferior directions.

The words distal and distally refer to being towards the end of theinsertion section which extends towards a patient's trachea in use andthe words proximal and proximally refer to being towards the personcarrying out intubation in use.

It is known to provide a laryngoscope insertion section including a tubeguide which extends along the length of the insertion section. Forexample, WO 04/073510 (Gandarias) discloses a laryngoscope insertionsection including a tube guide which extends laterally from an elongatemember which contains apparatus to provide an image of a patient'slarynx in use. The tube guide has inferior and superior walls whichextend continuously along the length of the tube guide. An endotrachealtube may be fitted into the tube guide and the insertion of theendotracheal tube into a patient's larynx can be viewed by a user. Theendotracheal tube can then be detached from the insertion section whilstthe insertion section remains within a patient and the insertion sectioncan be removed, leaving the endotracheal tube in place.

Tube guides can facilitate intubation by ensuring that, once aninsertion section is in place and the patient's larynx sighted, anendotracheal tube is already in the correct location to be pushedforward and inserted into a patient's larynx. However, a potentialdisadvantage is that tube guides increase the bulk of the insertionsection. Accordingly, the present invention aims to provide an insertionsection with a tube guide in which the insertion section is adapted toreduce its bulk, to facilitate introduction of the insertion sectioninto a patient with an endotracheal tube in place within the tube guide.

Another problem with known insertion sections with tube guides is thatthey are typically designed for use with endotracheal tubes of a limitedrange of sizes. Some aspects of the present invention are directed toproviding insertion sections adapted to guide a wider operating range ofendotracheal tube sizes than known insertion sections with tube guides.

Furthermore, the laryngoscope disclosed in WO 04/073510 has a generallyJ-shaped insertion section which retains an endotracheal tube in agenerally J-shaped configuration. This has two significantdisadvantages. Firstly, the insertion of a J-shaped insertion sectioninto a patient's oral cavity can be difficult. A J-shaped insertionsection must be tilted backwards and forwards during insertion to insertthe distal end, manipulate the patient's anatomy and obtain a good viewof the patient's larynx. It is preferable to provide a laryngoscopewhich can be more readily inserted. Secondly, this arrangement meansthat, when the endotracheal tube is pushed forward to advance the tube,a resistive force is developed on the superior side of the tube guidewhere the endotracheal tube bends from being substantially straight tocurved, which increases friction. Some embodiments of the presentinvention aim to provide an insertion section which is easier to insertinto a patient and/or which has a tube guide along which an endotrachealtube can be more readily advanced.

Some aspects of the present invention aim to provide an insertionsection having a tube guide which is easier to operate, for examplebecause less force is required, than with known insertion sections withtube guides, or to provide improved adjustability.

SUMMARY OF THE INVENTION

According to a first aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, the tube guide comprising a plurality of tube guidingmembers having tube guiding surfaces which are arranged to contact andthereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member having a tube guiding surface on an inferior side thereoffor contacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein the insertion section comprises a firstregion, which is proximal of the tube guiding surface of the firstsuperior tube guiding member, where the thickness of the insertionsection is less than the sum of the external diameter of the largestexternal diameter endotracheal tube in an operating range ofendotracheal tube sizes plus the mean thickness of the inferior tubeguiding member plus the mean thickness of the first superior tubeguiding member.

Accordingly, at least in the first region, the insertion section isnarrower than would be the case if it had tube guiding walls whichextended both inferiorly and superiorly of a retained endotracheal tubein use, which walls ran continuously along the length of the insertionsection.

By the thickness of an insertion section, we refer to the displacement,parallel to a superior-inferior axis, from the most inferior point onthe inferior side of the insertion section to the most superior point onthe superior side of the insertion section, through a givencross-section orthogonal to the length of the insertion section. Wordssuch as “thick”, “thicker”, “narrow”, and “narrower” should be construedaccordingly.

By the mean thickness of a tube guiding member we refer to the meandistance from the inferior side to the superior side where the tubeguiding surface of the tube guiding member is most inferior or mostsuperior, as appropriate, along the length of the tube guiding surfaceof the tube guiding member. We do not intend that the thickness of anyparts of tube guiding members which do not contact and thereby guide theinferior or superior surface of retained endotracheal tubes are takeninto account when assessing the mean thickness of a tube guiding memberas any such part is not subject to the same strength requirements as theparts which contact and thereby guide the inferior or superior surfaceof retained endotracheal tubes and it is these strength requirementswhich typically determine the minimum thickness of a tube guidingmember. The tube guiding surfaces of the or each superior tube guidingmember may extend along the length of, or along part of the length of,the or each superior tube guiding member. The tube guiding surface ofthe inferior tube guiding member may extend along the length of, or partof the length of, the inferior tube guiding member.

Preferably, the insertion section is configured such that, in the firstregion, the combined thickness of the insertion section and a retainedendotracheal tube having the largest external diameter in the operatingrange of endotracheal tube sizes, is less than the sum of the externaldiameter of the largest external diameter endotracheal tube in theoperating range of endotracheal tube sizes plus the mean thickness ofthe inferior tube guiding member plus the mean thickness of the firstsuperior tube guiding member.

At least a part of, and optionally all of, the tube guiding surface ofthe first superior tube guiding member may be opposite at least a partof the tube guiding surface of the inferior tube guiding member.Alternatively, the tube guiding surface of the first superior tubeguiding member and the tube guiding surface of the inferior tube guidingmember may not be opposite each other.

By providing an elongate laryngoscope insertion section having a firstregion which has a thickness that is less than the sum of the externaldiameter of the largest external diameter endotracheal tube in anoperating range of endotracheal tube sizes plus the mean thickness ofthe inferior tube guiding member plus the mean thickness of the firstsuperior tube guiding member, the insertion section is narrower at thefirst region in use than would be the case if tube guiding members ofthe same thickness as the inferior and first superior tube guidingmembers were provided in the first region and spaced apart sufficientlyto receive an endotracheal tube having the largest external diameter inan operating range of endotracheal tubes.

By the external diameter of the largest external diameter endotrachealtube in an operating range of endotracheal tube sizes, we refer to theexternal diameter of the largest external diameter endotracheal tubeswith which the insertion section can be reliably used. This will dependon the scale of the insertion section which will itself depend on theapplication of the insertion section. An insertion section for use withadult humans may, for example, be adapted to be usable reliably withendotracheal tubes with an external diameter of up to 12.3 mm. Tubes ofthis external diameter are referred to as Size 9.0 in the field. Theminimum external diameter may be around 5.5 mm. Where the insertionsection is made from a plastics material, the mean thickness of theinferior and first superior tube guiding members typically requires tobe at least 0.75 mm (preferably around 1.5 mm) to provide suitablemechanical strength for internal use. Accordingly, the thickness of thefirst region is preferably less than 15.3 mm, more preferably less than14.6 mm, 13.8 mm or more preferably less than 13.1 mm, in the case of aninsertion section for inserting endotracheal tubes into adult humans.

The dimensions of an insertion section for use with infant humans,including new born infants, are typically scaled proportionately fromthe dimensions of an insertion section for use with human adults.Nevertheless, the proportions of some features, such as the thickness ofthe tube guiding members, may not scale proportionately. In the case ofan insertion section for inserting endotracheal tubes into infanthumans, including new born infants, the operating range of external tubediameters may be 1.0 to 5.0 mm, and the thickness of the first region ispreferably less than 8.0 mm, preferably less than 7.0 mm, or morepreferably less than 6.0 mm.

The thickness of the insertion section at the first region may be lessthan the external diameter of the largest diameter endotracheal tube inthe operating range of endotracheal tube sizes.

The first region may extend from the proximal end of the insertionsection to the proximal end of the tube guiding surface of the firstsuperior tube contacting member. The first region may extend from theproximal end of the insertion section to the proximal end of the firstsuperior tube contacting member. The first region may include part ofthe proximal half of the insertion section but not extend to theproximal end of the insertion section. The first region preferablycomprises a region of the insertion section which is close to apatient's teeth when the insertion section is fully inserted into apatient, as this can reduce the risk of damage to a patient's teeth.

The insertion section is typically curved such that at least a portionof the superior surface is excurvate and at least a portion of theinferior surface is incurvate. The first superior tube guiding member istypically provided towards the distal end of the insertion section.Preferably, the first superior tube guiding member is provided close to,but not at, the distal end of the insertion section. Typically, thefirst superior tube guiding member guides a retained endotracheal tubetowards a patient's larynx. Typically, the tube guiding surface of thefirst superior tube guiding member and the tube guiding surface of theinferior tube guiding member together guide a retained endotracheal tubetowards a patient's trachea in use.

Typically, the tube guiding surface of the first superior tube guidingmember is the most distal location where the insertion section contactsthe superior surface of a retained endotracheal tube. Typically, thetube guiding surface of the inferior tube guiding member is the mostdistal location where the insertion section contacts the inferiorsurface of a retained endotracheal tube for endotracheal tubes of arange of external diameters (typically at the upper end of the operatingrange of endotracheal tube sizes). The insertion section may beconfigured such that endotracheal tubes at the lower end of theoperating range of endotracheal tube sizes do not contact the inferiortube guiding member opposite the first superior tube guiding member butendotracheal tubes at the upper end of the operating range ofendotracheal tube sizes do contact the inferior tube guiding memberopposite the first superior tube guiding member.

Preferably, the tube guide is arranged to guide a retained endotrachealtube such that the inferior surface of a retained endotracheal tube isinferior of the superior surface of the insertion section and thesuperior surface of a retained endotracheal tube is superior of theinferior surface of a retained endotracheal tube at least in the firstregion and typically from where the insertion section extends between apatient's teeth in use and the first superior tube guiding member. Thisarrangement fits better with the general shape of the oral cavity thandevices where the endotracheal tube is retained entirely inferiorly orentirely superiorly of the insertion section at a corresponding region.

The insertion section typically comprises a curved portion (for example,the insertion section may be entirely curved) such that the inferiorsurface of the insertion section is incurvate and the superior surfaceof the insertion section is excurvate. The first superior tube guidingmember is located sufficient distally of the first region to guide aretained tube at an angle of at least 20°, and preferably at least 30°to the angle at which a retained tube is guided in the first region. Thefirst superior tube guiding member is preferably arranged to guide anendotracheal tube towards a patient's larynx when the insertion sectionis fully inserted in use.

The first region of the insertion section which has a thickness which isless than the sum of the external diameter of the largest externaldiameter endotracheal tube in an operating range of endotracheal tubesizes plus the mean thickness of the inferior tube guiding member plusthe mean thickness of the first superior tube guiding member preferablyextends along at least 1 cm of the length of the insertion section. Morepreferably, the first region extends along at least 1.5 cm, and morepreferably at least 2.5 cm, of the length of the insertion section whichis close to a patient's teeth in use, to provide a user with aninsertion section which is relatively thin along a significant length ofthe insertion section to increase maneuverability and reduce the risk ofdamage to a patient's teeth.

The plurality of tube guiding members may further comprise a secondsuperior tube guiding member having a tube guiding surface on aninferior side thereof for contacting and thereby guiding the superiorsurface of a retained endotracheal tube, wherein the second superiortube guiding member is proximal of the first superior tube guidingmember and the tube guiding surfaces of the first and second superiortube guiding members are spaced apart. Thus, the superior surface of aretained endotracheal tube will typically be exposed between the firstand second superior tube guiding members.

In an insertion section for the intubation of human adults, the tubeguiding surfaces of the first and second superior tube guiding membersare typically spaced apart by at least 2 cm, more preferably at least 4cm and most preferably at least 6 cm. When the insertion section iscurved, the direction of the insertion section at the first superiortube guiding member typically differs by at least 20° and preferably atleast 30° from the direction of the insertion section at the secondsuperior tube guiding member.

Preferably, the first superior tube guiding member is located towards,but not at, the distal end of the insertion section.

The second superior tube guiding member may be arranged to be locatedclose to the teeth of a patient of typical dimensions when the insertionsection is fully inserted into a patient. The first region may comprisesome or all of the second superior tube guiding member. The secondsuperior tube guiding member may be located proximal of the teeth of apatient of typical dimensions when the insertion section is fullyinserted into a patient such that it would not pass into the oral cavityof a patient of typical dimensions in use.

Preferably, the insertion section is arranged to leave the inferiorsurface of a retained endotracheal tube exposed opposite the secondsuperior tube guiding member. Typically, no inferior tube guiding memberis provided opposite the second superior tube guiding member.

Preferably, the insertion section is arranged to leave the superiorsurface of a retained endotracheal tube exposed opposite at least theproximal end of and optionally all of the inferior tube guiding member.It may be that no superior tube guiding member is provided opposite atleast the proximal end of and optionally all of the inferior tubeguiding member.

Thus, at least a region of the insertion section close to a patient'steeth in use is narrower than would be the case if an inferior tubeguiding member was provided opposite the second superior tube guidingmember and spaced apart from the second tube guiding member so as toleave a gap therebetween with a thickness at least equal to the externaldiameter of the largest endotracheal tube in an operating range ofendotracheal tubes.

Preferably, the distal end of the tube guiding surface of the secondsuperior tube guiding member and the proximal end of the tube guidingsurface of the inferior tube guiding member are spaced apart along thelength of the insertion section, preferably by at least 0.5 cm, morepreferably by at least 1 cm and most preferably by at least 2 cm.Preferably also, the distal end of the second tube guiding member andthe proximal end of the inferior tube guiding member are spaced apartalong the length of the insertion section, preferably by at least 0.5cm, preferably by at least 1 cm and most preferably by at least 2 cm.

Preferably, the component which is parallel to a superior-inferior axisof the displacement between the distal end of the tube guiding surfaceof the second superior tube guiding member and the proximal end of thetube guiding surface of the inferior tube guiding member is less thanthe external diameter of the largest external diameter endotracheal tubein an operating range of endotracheal tube sizes. Preferably also, thedistance between the distal end of the second tube guiding member andthe inferior tube guiding member, parallel to a superior-inferior axis,is less than the external diameter of the largest external diameterendotracheal tube in an operating range of endotracheal tube sizes.

Thus, the tube guide may be arranged to receive an endotracheal tubeother than parallel to the length of the insertion section, for example,the tube guide may be arranged to receive an endotracheal tube such thatit extends distally and superiorly between the proximal end of the tubeguiding surface of the inferior tube guiding member and the distal endof the tube guiding surface of the second superior tube guiding member.

Preferably, the thickness of the insertion section between the secondsuperior tube guiding member and the first tube guiding member is lessthan the thickness of the insertion section at one and preferably bothof the first and second superior tube guiding members.

Preferably, the tube guide is arranged such that, for endotracheal tubesof a range of external diameters (typically including endotracheal tubeshaving the largest external diameter in an operating range ofendotracheal tube sizes) a retained endotracheal tube will not beretained parallel to the length of the insertion section but have adifferent radius of curvature to the insertion section along at least aportion of the insertion section (typically from the most proximallocation where the insertion section contacts the superior surface of aretained endotracheal tube to the most distal location where theinsertion section contacts the superior surface of a retainedendotracheal tube). The tube guide may be arranged such thatendotracheal tubes having an external diameter at the top end of theoperating range of endotracheal tube sizes are retained with a smallerradius of curvature than the insertion section along at least a portionof the insertion section (typically from the most proximal locationwhere the insertion section contacts the superior surface of a retainedendotracheal tube to the most distal location where the insertionsection contacts the superior surface of a retained endotracheal tube).The tube guide may be arranged such that endotracheal tubes having anexternal diameter at the bottom end of the operating range ofendotracheal tube sizes are retained with a higher radius of curvaturethan the insertion section along at least a portion of the insertionsection (typically from the most proximal location where the insertionsection contacts the superior surface of a retained endotracheal tube tothe most distal location where the insertion section contacts thesuperior surface of a retained endotracheal tube).

In particular, the plurality of tube guiding members may comprise asecond superior tube guiding member having a tube guiding surface whichis spaced apart from the tube guiding surface of the first superior tubeguiding member and arranged such that, for endotracheal tubes of a rangeof external diameters (typically including endotracheal tubes having thelargest external diameter in an operating range of endotracheal tubesizes), a retained endotracheal tube will not be retained parallel tothe length of the insertion section between the first and secondsuperior tube guiding members.

The tube guide may be arranged such that, for at least some endotrachealtubes with an external diameter within an operating range of externaldiameters, the superior surface of a said retained endotracheal tubeextends superiorly of the superior surface of the insertion section(typically the superior surface of the elongate member, where provided),along at least a portion of the length of the insertion section, towardsthe middle of the insertion section. Typically, the tube guide isarranged such that, for at least some endotracheal tubes with anexternal diameter within an operating range of external diameters, thesuperior surface of retained said endotracheal tube extends superiorlyof the superior surface of the insertion section at least one locationbetween the first and second superior tube guiding members, whereprovided.

Preferably, the tube guiding members are arranged such that, forendotracheal tubes having a range of external diameters within theoperating range of endotracheal tube external diameters (typically atthe upper end of the operating range of endotracheal tube externaldiameters) a retained endotracheal tube will typically contact the tubeguiding surface of either one of or preferably both the proximal anddistal superior tube guiding members only at the distal ends of therespective tube guiding member, when a retained endotracheal tube is atrest, retained within the tube guide. Endotracheal tubes having a rangeof external diameters within the operating range of endotracheal tubeexternal diameters (typically at the upper end of the operating range ofendotracheal tube external diameters) may only contact the tube guidingsurface of the inferior tube guiding member at the proximal end of thetube guiding surface, when a retained endotracheal tube is at rest,retained within the tube guide. This arrangement reduces friction whenthe endotracheal tube is subsequently advanced towards a patient'slarynx.

Preferably, the tube guide is arranged to retain an endotracheal tubeunder flexural tension from the most proximal location where the tubeguide contacts the superior surface of a retained endotracheal tube tothe most distal location where the tube guide contacts the superiorsurface of a retained endotracheal tube. This facilitates retention ofthe endotracheal tube within the tube guide. Preferably, the tube guidealso contacts the inferior surface of a retained endotracheal tubeintermediate the most proximal and most distal locations where the tubeguide contacts the superior surface of a retained endotracheal tube,such that a retained endotracheal tube exerts a superior force on thetube guide at the most proximal and most distal locations where the tubeguide contacts the superior surface of a retained endotracheal tube andan inferior force at the said location where the tube guide contacts theinferior surface of a retained endotracheal tube. The use of at leastthree points of contact facilitates grip. The retention of anendotracheal tube under flexural tension is of particular benefit wherethe tube guide opens laterally as the flexural tension increases thefriction which opposes lateral movement of the retained endotrachealtube. Nevertheless, the use of only three points of contact reducesfriction when the endotracheal tube is advance longitudinally comparedto an arrangement in which a retained endotracheal tube is in contactwith a guide wall along a substantial portion of the tube guide.

The tube guiding surface of the first superior tube guiding member mayextend distally and inferiorly (i.e. such that it extends inferiorlytowards the distal end) at an angle to the insertion section. Similarly,the second superior tube guiding member, where present, may extenddistally and superiorly (i.e. such that it extends superiorly towardsthe distal end). This facilitates the retention of an endotracheal tubein a curved configuration, under flexural tension.

The tube guide may be arranged such that, for endotracheal tubes of arange of external diameters (typically including endotracheal tubeshaving the largest external diameter in an operating range ofendotracheal tube sizes), a retained endotracheal tube is continuouslycurved from where it extends into a patient's mouth when it is fullyinserted in use to the first superior tube guiding member. Where asecond superior tube guiding member is provided, the tube guide may bearranged such that, for endotracheal tubes of a range of externaldiameters (typically including endotracheal tubes having the largestexternal diameter in an operating range of endotracheal tube sizes), aretained endotracheal tube is continuously curved from the secondsuperior tube guiding member to the first superior tube guiding member.

The curvature may or may not be constant.

Where the tube guiding surfaces of the first and second superior tubeguiding members are spaced apart such that the superior surface of aretained endotracheal tube is exposed between the first and secondsuperior tube guiding members, and the tube guide is arranged so thatfor endotracheal tubes of a range of external diameters (typicallyincluding endotracheal tubes having the largest external diameter in anoperating range of endotracheal tube sizes), said retained endotrachealtubes are continuously curved from where they extend into a patient'smouth when the insertion section is fully inserted in use to the firstsuperior tube guiding member, this enables the insertion section andtube guide to be used with endotracheal tubes of a wider range ofdiameters than would be the case for a tube guide defined by continuousinferior and superior tube guiding surfaces.

Preferably, the insertion section only includes one or more tube guidingsurfaces which extend to contact and thereby guide the inferior surfaceof a retained endotracheal tube distally of a patient's teeth when theinsertion section is fully inserted into a patient. Accordingly, thetube guide preferably only covers the inferior surface of a retainedendotracheal tube distally of a patient's teeth when the insertionsection is fully inserted into a patient.

The tube guiding surface of the inferior tube guiding member preferablyextends proximally of the tube guiding surface of the first superiortube guiding member. Thus, the inferior surface of a retainedendotracheal tube may be guided proximally of the first superior tubeguiding member without the superior surface of a retained endotrachealtube being guided along the entire length of the tube guiding surface ofthe inferior tube guiding member. This reduces the overall bulk of theinsertion section as a retained tube can be guided adequately using afirst superior tube guiding member with only a relatively short tubeguiding surface and an inferior tube guiding member with a tube guidingsurface which extends distally of the tube guiding surface of the firstsuperior tube guiding member. Preferably, the tube guiding surface ofthe inferior tube guiding member extends at least 1 cm, preferably atleast 2 cm and most preferably 4 to 5 cm proximally of the tube guidingsurface of the first superior tube guiding member. The tube guidingsurface of the inferior tube guiding member may be entirely proximal ofthe tube guiding surface of the first superior tube guiding member,further reducing bulk.

Preferably, the tube guide is arranged such that a retained endotrachealtube can be removed laterally from the tube guide. This facilitatesremoval of the endotracheal tube in situ within a patient. Preferably,the insertion section is arranged such that a retained endotracheal tuberemains exposed along an entire lateral side (e.g. along the entirety ofthe most lateral point on the tube, along the length of the tube). Byavoiding covering the lateral side of a retained endotracheal tube, theoverall bulk of the insertion section is reduced.

Preferably, the insertion section comprises an elongate member whichextends along the majority of the length of the insertion section, withthe tube guide arranged to retain an endotracheal tube laterally of theelongate member. The tube guiding members preferably extend laterallyof, and typically from, the elongate member. The elongate member maycomprise imaging apparatus, such as an imaging device (e.g. a camera) orimage conduction apparatus (such as one or more fibre optic cables orone or more reflective surfaces) for imaging a patient's laryngeal areain use. The elongate member may comprise illumination apparatus, such asa light source, including a bulb or one or more fibre optical cablesthrough which light may be conducted, for illuminating a patient'slaryngopharynx in use. The elongate member may conduct one or more cabletherein, such as electrical wires which relay signals from an imagingdevice and/or provide power to an imaging device and/or light source,where present.

The elongate member may define a bore therein, which typically extendsfrom the proximal end of the elongate member, which may be athrough-bore which is open at both ends or which may be enclosed at adistal end of the bore. The bore may be configured to receive imagingapparatus and/or illumination apparatus. The bore may be configured toreceive an elongate insertion section supporting member which resistsflexing of the insertion section. The bore may be configured to receivean elongate insertion section supporting member which comprises imagingapparatus and/or illumination apparatus. Where the bore is enclosed at adistal end, the elongate member is preferably liquid tight to preventcontamination of imaging apparatus and/or illumination apparatusenclosed therein.

Preferably, at least one location where the insertion section comprisesa said elongate member with an adjacent tube guide, the elongate memberand tube guide are configured such that the thickness of the elongatemember is less than the thickness of the adjacent tube guide plus theexternal diameter of a retained endotracheal tube having the largestexternal diameter in the operating range of endotracheal tube sizes. Thesaid location may be adjacent to the first superior tube guiding member.The said location may be adjacent to the inferior tube guiding member.The said location may be adjacent to the second superior tube guidingmember, where provided.

Accordingly, by providing an elongate member which is narrower than theadjacent tube guide, we provide an insertion section which is less bulkythan would be the case if the elongate member was the same thickness asthe tube guide.

Preferably, at least one location where the tube guide comprises asuperior tube guiding member, such as the first superior tube guidingmember, or a further tube guiding member which is proximal of the firstsuperior tube guiding member, where provided, the superior tube guidingmember extends further in a superior direction than the elongate member,adjacent to the superior tube guiding member.

Preferably, at least one location where the tube guide comprises aninferior tube guiding member, the inferior tube guiding member extendsfurther in an inferior direction than the elongate member, adjacent tothe inferior tube guiding member.

Accordingly, by providing a superior tube guiding member which extendsfurther in a superior direction than the adjacent elongate member and/oran inferior tube guiding member which extends further in a superiordirection than the adjacent elongate member, a less bulky insertionsection with a lateral tube guide is provided than would be the case ifthe superior tube guiding member did not extend further in a superiordirection than the adjacent elongate member and/or the inferior tubeguiding member did not extend further in an inferior direction than theadjacent elongate member.

Preferably, where the insertion section comprises an elongate memberwith an adjacent tube guide arranged to retain an endotracheal tubelaterally of the elongate member, there is at least one location,proximal of the first superior tube guiding member, where anendotracheal tube is retained in use laterally of the elongate memberwith the inferior and superior sides of the endotracheal tube being leftexposed. Preferably, no tube guiding member is provided at the location.Where first and second superior tube guiding members are provided, thesaid location is typically intermediate the first and second superiortube guiding members.

In the first region, or a portion of the first region, a retainedendotracheal tube at the upper end of the operating range ofendotracheal tube sizes may have both its inferior and superior surfacesleft exposed in use and extend inferiorly and superiorly of an adjacentsection of elongate member. Thus, in the first region, or a portion ofthe first region, the thickness of the insertion section may be lessthan three-quarters, or preferably less than half of the externaldiameter of the largest external diameter endotracheal tube in anoperating range of endotracheal tube sizes.

Preferably, the first superior tube guiding member extends laterally andsuperiorly from the elongate member, from the superior surface of theelongate member or from the lateral edge of the elongate memberintermediate the inferior and superior surfaces of the elongate member.Where a second superior tube guiding member is provided, the secondsuperior tube guiding member preferably extends laterally and superiorlyfrom the elongate member, from the superior surface of the elongatemember or from the lateral edge of the elongate member intermediate theinferior and superior surfaces of the elongate member.

The first superior tube guiding member and/or second superior tubeguiding member, where present, typically comprises a lateral portionwhich is arranged to extend distally and inferiorly beyond the midlineof a retained endotracheal tube. Thus, the tube guiding surface of thefirst superior tube guiding member (and second superior tube guidingmember when present) is typically incurvate.

Preferably, the inferior tube guiding member extends laterally andinferiorly from the elongate member. The inferior tube guiding membertypically comprises a lateral portion which is arranged to extenddistally and superiorly beyond the midline of a retained endotrachealtube. This, the tube guiding surface of the inferior tube guiding memberis typically incurvate.

Preferably, the lateral extent of the tube guiding members from theelongate member exceeds at least 50%, more preferably at least 60%, ormore preferably at least 70% of the diameter of the largest endotrachealtubes in an operating range of endotracheal tube sizes in order toextend past the midline of and thereby guide endotracheal tubes. Forexample, where the operating range of endotracheal tube sizes extends upto 12.3 mm, the tube guiding members preferably extend at least 6.1 mm(more preferably at least 7.3 mm and most preferably at least 8.5 mm)laterally from the elongate member. Where the operating range ofendotracheal tube sizes extends up to 5.0 mm, the tube guiding memberspreferably extend at least 2.5 mm laterally from the elongate member.

The inferior tube guiding member is preferably continuous but mayalternatively be discontinuous. Where an elongate member is present, theinferior tube guiding member typically extends from, or from near, theinferior side of the elongate member. The inferior surface of the tubeguiding member may be level with the inferior side of the tube guide.The inferior tube guiding member may extend to the distal end of theinsertion section.

The first superior tube guiding member may comprise two or more separateportions or be continuous. Where present, the second superior tubeguiding member may comprise two or more separate portions or becontinuous.

Preferably, the insertion section is arranged so that an intubater cancontact an endotracheal tube retained by the tube guide within apatient's mouth, in use. This increases the amount of control which isavailable to the intubater and may be preferred by intubaters who havebeen trained to carry out intubation using traditional laryngoscopes,who are used to being able to manipulate the endotracheal tube withinthe patient's mouth. Where the insertion section comprises a secondsuperior tube guiding member having a tube guiding surface which isspaced apart from the tube guiding surface of the first superior tubeguiding member, the insertion section may be arranged so that anintubater can contact an endotracheal tube distally of the tube guidingsurface of the section superior tube guiding member. The insertionsection may be arranged to that an intubater can contact one or more ofthe inferior or superior surfaces of an endotracheal tube retainedwithin the tube guide within a patient's mouth, in use (e.g. distally ofthe distally of the tube guiding surface of the second superior tubeguiding member, where present). The insertion section may be arranged tothat an intubater can contact a lateral surface of an endotracheal tuberetained within the tube guide within a patient's mouth, in use (e.g.distally of the distally of the tube guiding surface of the secondsuperior tube guiding member, where present). The insertion section maybe arranged so that an intubater can contact opposite inferior andsuperior surfaces of the endotracheal tube within a patient's mouth, inuse, (e.g. distally of the distally of the tube guiding surface of thesecond superior tube guiding member, where present), to facilitate gripand enable them to gently pinch the tube.

Preferably, the insertion section is rigid. Preferably, at least part ofthe insertion section is transparent. The insertion section may be madefrom a plastics material. The insertion section may be moulded from aplastics material. The insertion section may be monolithic. Where theinsertion section comprises an elongate member having a bore, theinsertion section may function to protect optical apparatus within thebore in use. Accordingly, the insertion section may be disposable.

The insertion section may be an integral part of a laryngoscope, whichmay comprise a handle. The insertion section may be removably attachableto a laryngoscope body, which may comprise a handle. The insertionsection may function as a laryngoscope.

Preferably, the insertion section is of suitable size for use in theintubation of adults. Preferably, the operating range of endotrachealtube sizes includes endotracheal tubes having an external diameter of12.3 mm. The relevance of this size is that this is the externaldiameter of what is generally referred to in the industry as Size 9.0endotracheal tubes, being one of the largest sizes in common use.However, tubes of this size are sufficiently broad to present anengineering challenge if an insertion section is to be provided with anintegral tube guide which capable of operating reliably with tubes ofthese size but does not present an obstruction.

According to a second aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, the tube guide comprising a plurality of tube guidingmembers having tube guiding surfaces which are arranged to contact andthereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and first and second superiortube guiding members each of which has a tube guiding surface on aninferior side thereof for contacting and thereby guiding the superiorsurface of a retained endotracheal tube, wherein the second superiortube guiding member is proximal of the first superior tube guidingmember and the tube guiding surfaces of the first and second superiortube guiding members are spaced apart, wherein the tube guide isarranged to leave exposed the inferior surface of a retainedendotracheal tube opposite the tube guiding surface of the secondsuperior tube guiding member.

According to a third aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, the tube guide comprising a plurality of tube guidingmembers having tube guiding surfaces which are arranged to contact andthereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member having a tube guiding surface on an inferior side thereoffor contacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein the tube guiding surface of the inferior tubeguiding member extends proximally of the tube guiding surface of thefirst tube guiding member.

The tube guide may further comprise a second superior tube guidingmember which has a tube guiding surface on an inferior side thereof forcontacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein the second superior tube guiding member isproximal of the first superior tube guiding member and the tube guidingsurfaces of the first and second superior tube guiding members arespaced apart, wherein the tube guiding surface of the second superiortube guiding member is spaced apart from and proximal of the proximalend of the tube guiding surface of the inferior tube guiding member,such that an endotracheal tube can be introduced into the tube guidebetween the proximal end of the tube guiding surface of the inferiortube guiding member and the distal end of the tube guiding surface ofthe superior tube contacting member at an angle to the length of theinsertion section at the proximal end of the tube guiding surface of theinferior tube guiding member.

According to a fourth aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, the tube guide comprising a plurality of tube guidingmembers having tube guiding surfaces which are arranged to contact andthereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member at the distal end of the tube guide having a tube guidingsurface on an inferior side thereof for contacting and thereby guidingthe superior surface of a retained endotracheal tube, wherein the tubeguide is arranged so that, for endotracheal tubes of a range of externaldiameters, a retained endotracheal tube will be continuously curved atleast from where a retained endotracheal tube extends through apatient's teeth when the insertion section is inserted fully into apatient to the first superior tube guiding member.

As the tube guide is arranged to retain an endotracheal tube such thatit is curved at least from where a retained endotracheal tube extendsthrough a patient's teeth when the insertion section is inserted fullyinto a patient to the first superior tube guiding member, the tube willbe easier to insert than would be the case if the endotracheal tube wasretained in a generally J-shaped formation and the insertion sectionwill be easier to insert than if the insertion section was arranged in agenerally J-shaped formation.

The tube guide may be arranged to retain the endotracheal tube with aconstant radius of curvature.

The tube guide may be arranged such that a retained endotracheal tubehas a greater curvature between where it extends through a patient'steeth when the insertion section is inserted fully into a patient andthe first superior tube guiding member than the curvature of theinsertion section between where it extends through a patient's teethwhen the insertion section is inserted fully into a patient and thefirst superior tube guiding member.

According to a fifth aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx and an elongate member, wherein the tube guidecomprises a plurality of tube guiding members which extend laterally ofthe elongate member having tube guiding surfaces which are arranged tocontact and thereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member having a tube guiding surface on an inferior side thereoffor contacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein, at least one location along the length ofthe insertion section, the thickness of the elongate member is less thanthe thickness of the adjacent tube guide.

According to a sixth aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx and an elongate member, wherein the tube guidecomprises a plurality of tube guiding members which extend laterally ofthe elongate member and have tube guiding surfaces which are arranged tocontact and thereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member having a tube guiding surface on an inferior side thereoffor contacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein either or both (i) the inferior tube guidingmember extends further in an inferior direction than the elongate memberadjacent to the inferior tube guiding member or (ii) the superior tubeguiding member extends further in a superior direction than the elongatemember adjacent to the superior tube guiding member.

According to a seventh aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, wherein the tube guide is adapted to retainendotracheal tubes with a range of external diameters within anoperating range of endotracheal tube external diameters, under flexuraltension.

Preferably, the tube guide comprises a plurality of tube guiding membershaving tube guiding surfaces which are arranged to contact and therebyguide the inferior or superior surface of a retained endotracheal tube,the plurality of tube guiding members comprising at least an inferiortube guiding member having a tube guiding surface on a superior sidethereof for contacting and thereby guiding the inferior surface of aretained endotracheal tube, a first superior tube guiding member havinga tube guiding surface on an inferior side thereof for contacting andthereby guiding the superior surface of a retained endotracheal tube,and a second superior tube guiding member located proximally of thefirst superior tube guiding member and having a tube guiding surface onan inferior side thereof for contacting and thereby guiding the superiorsurface of a retained endotracheal tube, wherein the tube guidingsurfaces of the first and second superior tube guiding members arespaced apart, with at least a portion of the tube guiding surface of theinferior tube guiding member being proximal of the proximal end of thetube guiding surface of the first superior tube guiding member anddistal of the distal end of the tube guiding surface of the secondsuperior tube guiding member, wherein the tube guiding members arearranged to retain endotracheal tubes with a range of external diameterswithin an operating range of endotracheal tube external diameters underflexural tension such that a retained endotracheal tube exerts a forcein a superior direction on the first and second superior tube guidingmembers applying a force in an inferior direction and a force in aninferior direction on the inferior tube guiding member.

Preferably, the tube guide is arranged to that a retained endotrachealtube can be removed laterally from the tube guide. More preferably, theinsertion section comprises an elongate member and the tube guidingmembers extend laterally from the elongate member.

According to an eighth aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx and an elongate member, wherein the tube guidecomprises a plurality of tube guiding members which extend laterally ofthe elongate member and have tube guiding surfaces which are arranged tocontact and thereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member having a tube guiding surface on an inferior side thereoffor contacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein there is at least one location, proximal ofthe first superior tube guiding member, where an endotracheal tube isretained in use laterally of the elongate member with the inferior andsuperior sides of the endotracheal tube being left exposed.

According to a ninth aspect of the present invention there is providedan elongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, wherein the insertion section and tube guide arearranged to leave the inferior or superior surface of a retainedendotracheal tube exposed along at least 25% and preferably 50% or morepreferably 75% of the length of the insertion section between the mostproximal location where the insertion section contacts a retainedendotracheal tube and the most distal location where the insertionsection contacts a retained endotracheal tube.

Preferably, the inferior surface of a retained endotracheal tube is leftexposed along at least 25% and preferably 50% or more preferably 75% ofthe length of the insertion section between the most proximal locationwhere the insertion section contacts a retained endotracheal tube andthe most distal location where the insertion section contacts a retainedendotracheal tube.

Preferably, the superior surface of a retained endotracheal tube is leftexposed along at least 25% and preferably 50% or more preferably 75% ofthe length of the insertion section between the most proximal locationwhere the insertion section contacts a retained endotracheal tube andthe most distal location where the insertion section contacts a retainedendotracheal tube.

Preferably, both the inferior and superior surface of a retainedendotracheal tube are left exposed along a continuous region of at least5% or preferably at least 10% of the length of the insertion sectionbetween the most proximal location where the insertion section contactsa retained endotracheal tube and the most distal location where theinsertion section contacts a retained endotracheal tube. Preferably, thecontinuous region is located close to the teeth of a patient of typicaldimensions when the insertion section is inserted fully into a patientin use.

Preferably, the tube guide is arranged to enable a retained endotrachealtube to be removed laterally from the tube guide and a retainedendotracheal tube is retained with its lateral side at least partiallyexposed along the entire length of the insertion section.

Preferably, the insertion section comprises an elongate member, whereinthe tube guide comprises a plurality of tube guiding members whichextend laterally of the elongate member and have tube guiding surfaceswhich are arranged to contact and thereby guide the inferior or superiorsurface of a retained endotracheal tube, the plurality of tube guidingmembers comprising at least a first superior tube guiding member havinga tube guiding surface on an inferior side thereof for contacting andthereby guiding the superior surface of a retained endotracheal tube anda second superior tube guiding member having a tube guiding surface onan inferior side thereof for contacting and thereby guiding the superiorsurface of a retained endotracheal tube, wherein the second superiortube guiding member is located proximally of the first superior tubeguiding member and the tube guiding surfaces of the first and secondsuperior tube guiding members are spaced apart, wherein the tube guidingsurface of the second superior tube guiding member is the most proximallocation where the insertion section contacts a retained endotrachealtube. The tube guiding surface of the first superior tube guiding memberis preferably the most distal location where the insertion sectioncontacts the superior side of a retained endotracheal tube and the tubeguiding surface of the first superior tube guiding member may be themost distal location where the insertion section contacts a retainedendotracheal tube.

Optional features discussed in relation to any of the first throughninth aspects of the invention are optional features of any of the firstthrough ninth aspects of the invention.

The invention also extends, in a tenth aspect, to a laryngoscopecomprising a handle and an elongate insertion section according to anyone of the first nine aspects of the invention.

The insertion section may be fixedly attached to the handle.Alternatively, the laryngoscope may comprise a body which comprises thehandle and the elongate insertion section may be detachably retainableon the body. The insertion section may comprise an elongate memberhaving a bore therein and the body may comprise an insertion sectionsupporting member which extends into and support the insertion section.Further optional and preferred features of the insertion sectionsupporting member, elongate member and bore correspond to thosediscussed above in relation to the first nine aspects of the invention.

DESCRIPTION OF THE DRAWINGS

An example embodiment of the present invention will now be illustratedwith reference to the following Figures in which:

FIG. 1 is an orthogonal view from a lateral position of a laryngoscopeinsertion section according to the present invention;

FIGS. 2 to 4 are perspective views from a range of orientations of thelaryngoscope insertion section of FIG. 1;

FIG. 5 is an orthogonal view from a lateral position of the laryngoscopeinsertion section of FIG. 1 detachably retaining an endotracheal tubewith a diameter at the upper end of an operating range of endotrachealtube sizes;

FIG. 6 is a series of cross-sections through the insertion section andretained endotracheal tube of FIG. 5 along cut lines A-A, B-B, C-C andD-D;

FIG. 7 is a series of cross-sections through an alternative insertionsection and retained endotracheal tube along cut lines equivalent toA-A, B-B, C-C and D-D of FIG. 1;

FIG. 8 is a series of cross-sections through a further insertion sectionand retained endotracheal tube along cut lines equivalent to A-A, B-B,C-C and D-D of FIG. 1;

FIG. 9 is a series of cross-sections through a still further insertionsection and retained endotracheal tube along cut lines equivalent toA-A, B-B, C-C and D-D of FIG. 1;

FIG. 10 is an orthogonal view from a lateral position of thelaryngoscope insertion section of FIG. 1 detachably retaining anendotracheal tube with a diameter at the upper end of an operating rangeof endotracheal tube sizes;

FIG. 11 is an orthogonal view from a lateral position of thelaryngoscope insertion section of FIG. 1 detachably retaining anendotracheal tube with a diameter at the lower end of an operating rangeof endotracheal tube sizes; and

FIG. 12 corresponds to FIG. 10 including indications of the centre linesof the retained endotracheal tube and the insertion section.

DETAILED DESCRIPTION OF AN EXAMPLE EMBODIMENT

With reference to FIGS. 1 to 5, a laryngoscope insertion section for usewith adult humans, shown generally as 1, comprises an elongate member 2which extends from the proximal end of the insertion section 4 but doesnot extend as far as the distal end of the insertion section 6. Theelongate member has a light-permeable viewing port 8 at its distal end.An elongate bore 10 extends along the elongate member from the proximalend of the elongate member for receiving and retaining an insertionsection retaining protrusion of a laryngoscope and covering theinsertion section retaining protrusion to protect it from bodily fluidsin use. A retaining portion 12, which includes a fixing aperture 14 forengaging with a corresponding protrusion on an insertion sectionsupporting member of a laryngoscope, facilitates the removableattachment of the insertion section to a laryngoscope. The insertionsection may be used with a laryngoscope including a insertion sectionretaining member with a video camera and light source which is includedin the insertion section retaining member, so that light from the lightsource can illuminate a patient's trachea and the surrounding region andthe video camera can relay images of the patient's trachea and thesurrounding region to a display. A broad protrusion 16 extends from theend of the elongate member, which functions as a blade for contactingand typically lifting a patient's anatomy in use to provide clear accessto the larynx.

A tube guide extends laterally of the elongate member. The tube guidecomprises a distal superior tube guiding member 18, located towards thedistal end of the insertion section, which extends from the superiorside of the elongate member and functions as the first superior tubeguiding member. The inferior surface of the distal superior tube guidingmember includes a tube guiding surface 20 which is arranged to contactand thereby guide the superior surface of a retained endotracheal tube.A lateral edge 22 of the elongate member does not function as the tubeguiding surface as, although it may contact an endotracheal tube in use,it does not contact and thereby guide the superior surface of a retainedendotracheal tube.

The tube guide also comprises a proximal superior tube guiding member24, located towards the proximal end of the insertion section, whichextends laterally from the elongate member and functions as the secondsuperior tube guiding member. The inferior surface of the proximalsuperior tube guiding member also includes a tube guiding surface whichis arranged to contact and thereby guide the superior surface of aretained endotracheal tube.

The tube guiding surfaces of the proximal and distal superior tubeguiding members are generally incurvate. The proximal and superior tubeguiding members are of generally even thickness and extend laterally andsuperiorly from the elongate member, from a location on the lateral sideof the elongate member which is near to but not level with the superiorsurface 25 of the elongate member. They extend superiorly to thesuperior surface of the elongate member, curve over a retainedendotracheal tube in use and then curve laterally and inferiorly toextend over and guide the superior surface of a retained endotrachealtube. The tube guiding surface of the proximal superior tube guidingmember extends superiorly relative to the insertion section towards itsdistal end. The tube guiding surface of the distal superior tube guidingmember extends inferiorly relative to the insertion section towards itsdistal end. This arrangement facilitates the retention of anendotracheal tube with a greater curvature than the insertion section.

An inferior tube guiding member 26 extends from a location which isdistal of the proximal superior tube guiding member towards the distalend of the insertion section. The inferior tube guiding member comprisesa tube guiding surface which is arranged to contact and thereby guidethe inferior surface of a retained endotracheal tube. The inferior tubeguiding member tapers at a proximal end and so it also comprises aninferior surface portion 28 which does not function as a tube guidingsurface because it does not contact and thereby guide the inferiorsurface of a retained endotracheal tube in use.

The tube guiding surfaces of the inferior tube guiding member is alsogenerally incurvate. The inferior tube guiding member is of generallyeven thickness and extends laterally and inferiorly from the elongatemember, from a location on the lateral edge of the elongate member whichis near to but not level with the inferior surface 25 of the elongatemember. The inferior tube guiding member extends inferiorly to theinferior surface of the elongate member, curves over a retainedendotracheal tube in use and then curves laterally and superiorly toextend under and guide the inferior surface of a retained endotrachealtube.

The tube guide is arranged to leave the inferior and superior surfacesof a retained endotracheal tube exposed along a majority of the lengthof the insertion section between the most proximal and most distallocations where the endotracheal tube contacts a retained endotrachealtube. In an insertion section for use with adult humans, the length ofthe proximal superior tube guiding member, along its most superiorregion, may be approximately 22 mm and the length of the distal superiortube guiding member, along its most superior region, may beapproximately 15 mm. The distance between the distal end of the proximalsuperior tube guiding member and the proximal end of the distal superiortube guiding member, following the curve of the insertion section,between the most superior regions of the proximal and distal superiortube guiding members, may be approximately 68 mm, or 65 mm in a directline. The distance between the proximal end of the inferior tube guidingmember and the distal end of the proximal superior tube guiding membermay be approximately 25 mm and the inferior tube guiding member mayextend approximately 45 mm proximally of the proximal end of the distalsuperior tube guiding member.

The inferior tube guiding member and the distal superior tube guidingmember are arranged to guide a retained endotracheal tube 29 towards apatients' trachea in use. The tube guiding surfaces of the proximal anddistal superior tube guiding members are spaced apart because theproximal and distal superior tube guiding members are spaced apart. Thesuperior surface of a retained endotracheal tube is exposed between thetube guiding surfaces of the proximal and distal superior tube guidingmembers. The inferior tube guiding member extends proximally of thedistal superior tube guiding member and so there is a region where aretained endotracheal tube is guided on its inferior side but not itssuperior side. The proximal end 30 of the tube guiding surface inferiortube guiding member is spaced apart from the distal end 32 of theproximal superior tube guiding member, by a sufficient distance toenable a 12.3 mm external diameter endotracheal tube (being the upperend of an operating range of endotracheal tube sizes) to be introducedat an angle to the centre line of the insertion section.

FIG. 6 comprises a series of cross-sections through the insertionsection of FIG. 5 along cut lines A-A, B-B, C-C and D-D. Note that inthis arrangement the superior surface of the proximal superior tubeguiding member is substantially in line with the superior surface of theelongate member (A-A) and the endotracheal tube (which has a diameter of12.3 mm) has a superior surface which extends superiorly of the superiorsurface of the adjacent elongate member (C-C). Level with the distalsuperior tube guiding member (D-D), the inferior surface of the inferiortube guiding member extends further in an inferior direction than theinferior surface of the elongate member. Furthermore, level with thedistal superior tube guiding member, the superior surface of the distalsuperior tube guiding member extends further in a superior directionthan the superior surface of the elongate member.

FIG. 7 comprises a series of cross-sections through an alternativeinsertion section along cut lines which are equivalent to A-A, B-B, C-Cand D-D. In this embodiment, the inferior tube guiding member is notincurvate but has an inferior surface which is level with the inferiorsurface of the elongate member and the superior surface of the distalsuperior tube guiding member extends superiorly of the superior surfaceof the elongate member. The superior surface of the proximal superiortube guiding member extends further in a superior direction than thesuperior surface of the elongate member (A-A). At the proximal end ofthe inferior tube guiding member, the inferior surface of the a retainedendotracheal tube with 12.3 mm diameter extends further in an inferiordirection than the inferior surface of the elongate member. Furtheralong the inferior tube guiding member, the inferior surface of theinferior tube guiding member extends inferiorly of the inferior surfaceof the elongate member.

FIG. 8 comprises a series of cross-sections through an alternativeinsertion section along cut lines which are equivalent to A-A, B-B, C-Cand D-D. In this embodiment, no proximal superior tube guiding member isprovided (A-A). The inferior tube guiding member extends furtherinferiorly than in the previous embodiments to facilitate smoothinsertion of the tube when it is pushed along its length by an intubator(C-C). The lateral surface of the elongate member comprises a slightelongate groove (B-B) to better retain an endotracheal tube within thetube guide. Level with the proximal half of the distal superior tubeguiding member (C-C), the inferior surface of the inferior tube guidingmember extends further in an inferior direction than the inferiorsurface of the elongate member. Furthermore, level with the proximalhalf distal superior tube guiding member, the superior surface of thedistal superior tube guiding member extends further in a superiordirection than the superior surface of the elongate member. The superiortube guiding member extends distally of the inferior tube guiding memberas illustrated at cross-section D-D.

The various cross-sections illustrated in FIGS. 6 to 8 may be combinedin any combination to form a range of insertion sections.

FIG. 9 comprises a series of cross-sections through a still furtheralternative insertion section along cut lines which are equivalent toA-A, B-B, C-C and D-D. In this embodiment, which has especially reducedbulk, the elongate member is narrower and the tube guiding membersextend significantly further in an inferior or superior direction, asappropriate, than the adjacent corresponding surface of the elongatemember. At cross section B-B, the retained 12.3 mm endotracheal tubeextends superiorly and inferiorly of the superior and inferior surfacesof the elongate member respectively. Accordingly, there is a region ofinsertion section, between the proximal distal superior tube guidingmember and the proximal end of the tube guiding surface of the inferiortube guiding member where the thickness of the insertion section is lessthan the thickness of the adjacent 12.3 mm endotracheal tube. At thislocation, and proximal of the proximal superior tube guiding member thethickness of the elongate member may be less than 8 mm and perhaps asthin as 3 mm or 4 mm.

The insertion section is typically moulded in one piece from atransparent plastics material and supplied sterilised within a sealedpackage.

In use, the insertion section is detachably mounted on an elongateinsertion section supporting member (not shown) which fits snugly withinthe bore. The elongate insertion section supporting member is typicallyattached to the handle of a laryngoscope body. A video camera,functioning as imaging apparatus and a light emitting diode, functioningas light source, are located on the distal tip of the elongate insertionsection supporting member, such that they are adjacent to the window inuse. Electric wires run down the length of the elongate insertionsection supporting member which supply power to the video camera andlight source.

The elongate strengthening section is typically fabricated from steel oranother rigid material. As well as supporting the video camera and lightsource and enclosing the electrical connections to the video camera andlight source, the elongate strengthening section functions to providesupport the insertion section, enabling it to be thinner than wouldotherwise be the case.

Once the insertion section has been attached to a laryngoscope body, anendotracheal tube within an operating range of endotracheal tube sizeswhich can be used reliably with the insertion section is inserted intothe tube guide, in contact with the tube guiding surfaces of theinferior tube guiding member and the proximal and distal tube guidingmembers. For an insertion section for use in the intubation of humanadults, a suitable operating range of external tube diameters would be 8mm to 12.3 mm.

The laryngoscope with insertion section is then introduced into apatient, the blade is used to contact, and perhaps lift, the patient'sanatomy to obtain clear access to the larynx. The light emitting diodeilluminates the patient's laryngeal area whilst images from the videocamera are relayed to a display which might be an integral part of thelaryngoscope or may be separate to the laryngoscope. The laryngoscope isinserted fully into a patient, i.e. to the point where an anaesthetistwould consider it to be optimally aligned for the introduction of anendotracheal tube. The endotracheal tube is then advanced forwardthrough the insertion section into the patient's larynx. Once the tubehas been successfully inserted, it can be detached laterally from theinsertion section and separated from the insertion section in situ. Theinsertion section can then be removed and the endotracheal tube left inplace.

Note that endotracheal tubes will be retained within the tube guideunder flexural tension. Although endotracheal tubes typically have aninherent curvature, the retained endotracheal tubes will be subject tobending forces in the inferior direction at both the proximal and distalsuperior tube guiding member and a force in the superior direction atleast a portion of the inferior tube guiding member. Endotracheal tubesare resilient and so they exert a force 42 in a superior direction on atleast the distal ends of the proximal and distal superior tube guidingmembers and a further force 44 in an inferior direction on at least aregion of (typically towards or at the proximal end) the inferior tubeguiding member. This improves the grip of the tube guiding members on aretained endotracheal tube enabling the tube guiding members to havelower profiles and to extend less far around retained endotracheal tubesthan would otherwise be the case, facilitating the provision of areliable laterally opening tube guide.

In practice, retained endotracheal tubes of at least some diameters(typically at the upper end of the operating range of endotracheal tubesizes) will typically contact the tube guiding surface of the proximaland distal superior tube guiding members only at the distal ends ofthese tube guiding members, due to the curved path of the retained tube,whilst the endotracheal tube is at rest within the guide. Other tubeguiding surfaces of the proximal and distal superior tube guidingmembers are relevant during the stage of inserting an endotracheal tubeinto the tube guide, although they could conceivably be omitted.Similarly, such endotracheal tubes will typically only contact the tubeguiding surface of the inferior tube guiding member towards the proximalend of the tube guiding surface, again due to the curved path of theretained endotracheal tube. This arrangement, in which the endotrachealtubes only contact a limited region of some or all of the tube guidingmembers reduces friction when the endotracheal tube is advanced into apatient's trachea.

The insertion section has a number of key advantages which result fromfeatures of the design. Firstly, the insertion section is adapted tominimise the risk of damaging a patient's teeth and to facilitate themaneuverability of the insertion section in the region of a patient'steeth as there is a substantial narrow region 34, functioning as thefirst region, where the thickness of the insertion section is less thanthe external diameter of the largest size of endotracheal tube in anoperating range of endotracheal tubes (12.3 mm in this example) plus thethickness of the inferior tube contacting member where it contacts theinferior surface of a retained endotracheal tube (at least 0.75 mm andtypically 1.5 mm) plus the thickness of the distal superior tubecontacting member where it contacts the superior surface of a retainedendotracheal tube (at least 0.75 mm and typically 1.5 mm). Although thenarrow region extends along the majority of the length of the insertionsection in this example, it would be useful to provide a narrow sectionwith a thickness which is less than the above-mentioned thickness, evenif it only extended along a short portion of the insertion section, suchas along a length of 2 cm, 1 cm or even 0.5 cm of the insertion section,close to a patient's teeth when the insertion section is fully insertedinto a patient of typical dimensions.

One feature which enables the thickness of the tube guide to remain lessthan the said thickness (15.3 mm in the present example) proximal of thedistal superior tube contacting member is the arrangement in which thetube guiding surfaces of the proximal and distal superior tubecontacting members are spaced apart, leaving the superior surface of aretained endotracheal tube exposed. The presence of an inferior tubeguiding member and a distal superior tube guiding member is sufficientto guide the tube. However, the arrangement in which the inferior tubeguiding member extends proximally of the tube guiding surface of thedistal superior tube guiding member and there is a region where thesuperior surface of a retained tube is left exposed opposite a firstregion of tube guiding surface of the inferior tube guiding member, hasthe benefit that a retained tube can be accurately guided by theinferior tube guiding member but the bulk of the insertion section isreduced by the omission of the a tube guiding member opposite the saidregion of the inferior tube guiding member.

Similarly, as no tube guiding surface is provided opposite the tubeguiding surface of the proximal superior tube guiding member, thethickness of the tube guide remains less than the said thickness (15.3mm in the present example) close to a patient's teeth in use.

There is a region between the distal end of the tube guiding surface ofthe proximal superior tube guiding member and the proximal end of thetube guiding surface of the inferior tube guiding member where aretained endotracheal tube is exposed on both its inferior and superiorsurfaces. This is advantageous firstly in that the overall bulk of theinsertion section has been reduced by omitting tube guiding members inthis region. This enables the inferior tube guiding member and aprojection of the superior tube guiding member to be spaced apart byless than the external diameter of an endotracheal tube at the top endof an operating range of tube sizes (12.3 mm external diameter in thepresent example).

Furthermore, this arrangement facilitates the introduction of anendotracheal tube at the top end of an operating range of tube sizes atan angle to the length of the insertion section. This is bestillustrated in FIG. 12 where it will be seen that the centre line 36 ofthe retained 12.3 mm endotracheal tube has a greater radius of curvaturethan the centre line of the insertion section 38 and, indeed, the mostsuperior point on the retained endotracheal tube is superior of thesuperior surface of the insertion section. Thus, the endotracheal tubeextends into the volume which would be occupied by a superior tubeguiding member if the superior tube guiding member had extended to theproximal end of the inferior tube guiding member. Accordingly, theinsertion section is thinner from the proximal superior tube guidingmember to the distal superior tube guiding member than would have beenthe case if the tube guide covered both the inferior and superiorsurface of a retained endotracheal tube along this length. Anendotracheal tube at the bottom end of the operating range ofendotracheal tube sizes might alternatively have a smaller radius ofcurvature and may not contact the inferior tube guiding member.

It is also notable that the thickness of the tube guide is greater levelwith the distal superior tube guiding member than the thickness of theadjacent elongate member. Furthermore, the superior surface of thedistal superior tube guiding member extends further in a superiordirection than the superior surface of the adjacent elongate member andthe inferior surface of the inferior tube guiding member extends furtherin an inferior direction than the inferior surface of the elongatemember adjacent to the inferior tube guiding member. Accordingly, theoverall bulk of the insertion section is less than would be the case ifthe inferior and superior surfaces of the tube guiding members extendedlevel with the inferior and superior surfaces respectively of theelongate member, along the entire length of the insertion section. Thissubstantially reduces the overall bulk of the insertion section,facilitating rapid intubation.

The maintenance of a retained endotracheal tube in a curved path isfacilitated by the provision of a distal superior tube contacting memberwhich has an inferior tube guiding surface which is at an angle to thecentre line of the insertion section, such that it extends inferiorlytowards its distal end. Similarly, the proximal superior tube contactingmember has an inferior tube guiding surface which is at an angle to thecentre line of the insertion section, such that it extends superiorlytowards its distal end.

In some embodiments, illustrated in FIG. 7, the superior surface of theproximal superior tube guiding member extends further in a superiordirection than the superior surface of the elongate member adjacent tothe proximal superior tube guiding member which reduces the bulk of theinsertion section in the region of a patient's teeth when the insertionsection is fully inserted into a patient's oral cavity.

In some embodiments, illustrated in FIG. 8, the proximal superior tubeguiding member is entirely omitted. The tube guiding surface of theinferior tube guiding member does not extend to the proximal end of theinsertion section. This reduces bulk further and is facilitated by theprovision of an inferior tube guiding member having a tube guidingsurface which does extend proximally of the proximal end of the tubeguiding surface of the distal superior tube guiding member. In someembodiments, the tube guiding surface of the distal superior tubeguiding member is entirely distal of the portion of the insertionsection (which is typically the most curved) which extend around thebase of a patient's tongue in use. However, in the embodimentillustrated in FIG. 8, the tube guiding surface of the distal superiortube contacting member does extend to the portion of the insertionsection which extends around the base of a patient's tongue in use.

In the embodiment of FIG. 9, the thickness of the elongate member issignificantly reduced, to less than the external diameter of the largestendotracheal tube in the operating range of endotracheal tubes, tofurther reduce the overall bulk of the insertion section.

A further benefit of arranging the tube guide such that a retainedendotracheal tube remains curved between the proximal end of theinsertion section and the distal superior tube guiding member is that,in contrast to J-shaped insertion sections with tube guides, theinsertion section can be more naturally introduced into a patient's oralcavity along a curved path. In contrast, J-shaped insertion sectionsrequire to be tilted backwards and forward as they inserted in amulti-stage process. Furthermore less force would be required to advancethe retained tube into a patient's trachea than with a J-shaped tubeguide, where significant force would be exerted on the tube guide wherethe straight portion began to curve. Endotracheal tubes are typicallyslightly curved and this arrangement facilitates convenient use ofslightly curved endotracheal tubes.

As a result of the design features which reduce the overall bulk of theinsertion section, the insertion section can be made of a size to workwith larger diameter endotracheal tubes. For example, an insertionsection which can be easily used for rapid insertion of a tube indifficult intubation situations can be provided which can be used withendotracheal tubes with a diameter of up to 12.3 mm.

Alternative insertion sections may be provided for use with infanthumans, or specific animals or groups of animals, such as horses. Inthis case, the insertion section may be scaled proportionately. Thelength, width and thickness of the insertion section as a whole aretypically scaled proportionately. Nevertheless, some dimensions, such asthe thickness of the tube guiding members, may not be scaledproportionately.

It will be seen that the tube guide has been arranged to retain anendotracheal tube laterally of the elongate member, fitting better withthe general shape of a patient's oral cavity than a tube guide whichretain an endotracheal tube inferiorly or superiorly of the insertionsection.

Although the illustrated embodiments show proximal and distal superiortube guiding members which finish abruptly so that the tube guidingsurfaces of the proximal and distal superior tube guiding membersterminate at the proximal and distal ends of each superior tube guidingmember, either or both of the proximal and distal superior tube guidingmembers could instead taper and include portions which did not functionas tube guiding surfaces which contact and thereby guide the superiorsurface of a retained endotracheal tube. For example, a lip extendingfrom the elongate member may connect the proximal and distal superiortube guiding members, but not affect the function of the inventionbecause the lip does not constitute a tube guiding surface within themeaning of the present invention.

Although the invention has been illustrated using a detachablyretainable insertion section portion, the insertion section mayalternatively be an integral part of a laryngoscope.

Further modifications and variations may be made within the scope of theinvention herein disclosed.

1. An elongate laryngoscope insertion section having a proximal end anda distal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, the tube guide comprising a plurality of tube guidingmembers having tube guiding surfaces which are arranged to contact andthereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member having a tube guiding surface on an inferior side thereoffor contacting and thereby guiding the superior surface of a retainedendotracheal tube, wherein the insertion section comprises a firstregion, which is proximal of the tube guiding surface of the firstsuperior tube guiding member, where the thickness of the insertionsection is less than the sum of the external diameter of the largestexternal diameter endotracheal tube in an operating range ofendotracheal tube sizes plus the mean thickness of the inferior tubeguiding member plus the mean thickness of the first superior tubeguiding member.
 2. An elongate laryngoscope insertion section accordingto claim 1, wherein the tube guide is arranged such that a retainedendotracheal tube can be removed laterally from the tube guide.
 3. Anelongate lateral laryngoscope insertion section according to claim 1,wherein the tube guide is arranged such that a retained endotrachealtube can be removed laterally from the tube guide in situ within apatient.
 4. An elongate laryngoscope insertion section according toclaim 1, wherein the insertion section is arranged such that a retainedendotracheal tube remains exposed along an entire lateral side.
 5. Anelongate laryngoscope insertion section according to claim 1, wherein atleast a part of the tube guiding surface of the first superior tubeguiding member is opposite at least a part of the tube guiding surfaceof the inferior tube guiding member.
 6. An elongate laryngoscopeinsertion section according to claim 1, wherein the first regioncomprises a region of the insertion section which is close to apatient's teeth when the insertion section is fully inserted into apatient.
 7. An elongate laryngoscope insertion section according toclaim 1, wherein the insertion section comprises a curved portion suchthat the inferior surface of the insertion section is incurvate and thesuperior surface of the insertion section is excurvate and the firstsuperior tube guiding member is located sufficient distally of the firstregion to guide a retained tube at an angle of at least 20° to the angleat which a retained tube is guided at the proximal end of the insertionsection.
 8. An elongate laryngoscope insertion section according toclaim 1, wherein the first region of the insertion section extends alongat least 1 cm of the length of the insertion section.
 9. An elongatelaryngoscope insertion section according to claim 1, wherein theplurality of tube guiding members further comprises a second superiortube guiding member having a tube guiding surface on an inferior sidethereof for contacting and thereby guiding the superior surface of aretained endotracheal tube, wherein the second superior tube guidingmember is proximal of the first superior tube guiding member and thetube guiding surfaces of the first and second superior tube guidingmembers are spaced apart.
 10. An elongate laryngoscope insertion sectionaccording to claim 9, wherein the tube guide is arranged such that thesuperior surface of a retained endotracheal tube is exposed between thefirst and second superior tube guiding members.
 11. An elongatelaryngoscope insertion section according to claim 9, arranged to leavethe inferior surface of a retained endotracheal tube exposed oppositethe second superior tube guiding member.
 12. An elongate laryngoscopeinsertion section according to claim 9, wherein the distal end of thetube guiding surface of the second superior tube guiding member and theproximal end of the tube guiding surface of the inferior tube guidingmember are spaced apart along the length of the insertion section. 13.An elongate laryngoscope section according to claim 12, wherein thecomponent which is parallel to a superior-inferior axis of thedisplacement between the distal end of the tube guiding surface of thesecond superior tube guiding member and the proximal end of the tubeguiding surface of the inferior tube guiding member is less than theexternal diameter of the largest external diameter endotracheal tube inan operating range of endotracheal tube sizes.
 14. An elongatelaryngoscope insertion section according to claim 9, wherein thethickness of the insertion section between the second superior tubeguiding member and the first tube guiding member is less than thethickness of the insertion section at one and preferably both of thefirst and second superior tube guiding members.
 15. An elongatelaryngoscope insertion section according to claim 9, wherein the tubeguiding members are arranged such that endotracheal tubes having a rangeof external diameters within the operating range of endotracheal tubeexternal diameters will contact the tube guiding surface of either oneof or preferably both the proximal and distal superior tube guidingmembers only at the distal ends of the respective tube guiding member,when a retained endotracheal tube is at rest, retained within the tubeguide.
 16. An elongate laryngoscope insertion section according to claim15, wherein endotracheal tubes having a range of external diameterswithin the operating range of endotracheal tube external diameters onlycontact the tube guiding surface of the inferior tube guiding member atthe proximal end of the tube guiding surface, when a retainedendotracheal tube is at rest, retained within the tube guide.
 17. Anelongate laryngoscope insertion section according to claim 1, whereinthe tube guide is arranged such that, for endotracheal tubes of a rangeof external diameters a retained endotracheal tube will not be retainedparallel to the length of the insertion section but have a differentradius of curvature than the insertion section along at least a portionof the insertion section.
 18. An elongate laryngoscope insertion sectionaccording to claim 17, wherein the tube guide is arranged such that, forthe largest endotracheal tubes in the operating range of externaldiameters a retained endotracheal tube will have a greater radius ofcurvature than the insertion section along at least a portion of theinsertion section and the smallest endotracheal tubes in the operatingrange of external diameters a retained endotracheal tube will have ashorter radius of curvature than the insertion section along at least aportion of the insertion section.
 19. An elongate laryngoscope insertionsection according to claim 1, wherein the tube guiding surface of thefirst superior tube guiding member extends inferiorly towards its distalend.
 20. An elongate laryngoscope insertion section according to claim1, wherein the insertion section only includes one or more tube guidingsurfaces which extend to contact and thereby guide the inferior surfaceof a retained endotracheal tube distally of a patient's teeth when theinsertion section is fully inserted into a patient.
 21. An elongatelaryngoscope insertion section according to claim 1, wherein the tubeguiding surface of the inferior tube guiding member extends proximallyof the tube guiding surface of the first superior tube guiding member.22. An elongate laryngoscope insertion section according to claim 1,comprising an elongate member which extends along the majority of thelength of the insertion section, with the tube guide arranged to retainan endotracheal tube laterally of the elongate member.
 23. An elongatelaryngoscope insertion section according to claim 22, wherein theelongate member comprises imaging apparatus or a bore configured toreceive an elongate insertion section supporting member which comprisesimaging apparatus and/or illumination apparatus.
 24. An elongatelaryngoscope insertion section according to claim 22, wherein at leastone location where the insertion section comprises a said elongatemember with an adjacent tube guide, the thickness of the elongate memberis less than the thickness of the adjacent tube guide in use.
 25. Anelongate laryngoscope insertion section according to claim 22, whereinat least one location where the tube guide comprises a superior tubeguiding member, the superior tube guiding member extends further in asuperior direction than the elongate member, adjacent to the superiortube guiding member.
 26. An elongate laryngoscope insertion sectionaccording to claim 22, wherein at least one location where the tubeguide comprises an inferior tube guiding member, the inferior tubeguiding member extends further in an inferior direction than theelongate member, adjacent to the inferior tube guiding member.
 27. Anelongate laryngoscope insertion section according to claim 1, whereinone of more of the tube guiding members are discontinuous.
 28. Anelongate laryngoscope insertion section according to claim 1, whereinthe insertion section is rigid, monolithic, disposable and at leastpartially transparent.
 29. An elongate laryngoscope insertion sectionaccording to claim 1, wherein the insertion section is removablyattachable to a laryngoscope body.
 30. An elongate laryngoscopeinsertion section having a proximal end and a distal end for insertioninto a patient's oral cavity in use, the insertion section comprising atube guide for removably retaining an endotracheal tube and guiding aretained endotracheal tube towards a patient's larynx, the tube guidecomprising a plurality of tube guiding members having tube guidingsurfaces which are arranged to contact and thereby guide the inferior orsuperior surface of a retained endotracheal tube, the plurality of tubeguiding members comprising at least an inferior tube guiding memberhaving a tube guiding surface on a superior side thereof for contactingand thereby guiding the inferior surface of a retained endotrachealtube, and first and second superior tube guiding members each of whichhas a tube guiding surface on an inferior side thereof for contactingand thereby guiding the superior surface of a retained endotrachealtube, wherein the second superior tube guiding member is proximal of thefirst superior tube guiding member and the tube guiding surfaces of thefirst and second superior tube guiding members are spaced apart, whereinthe tube guide is arranged to leave exposed the inferior surface of aretained endotracheal tube opposite the tube guiding surface of thesecond superior tube guiding member.
 31. An elongate laryngoscopeinsertion section according to claim 30, wherein the distal end of thetube guiding surface of the second superior tube guiding member isspaced apart from and proximal of the proximal end of the tube guidingsurface of the inferior tube guiding member, such that an endotrachealtube can be introduced into the tube guide between the proximal end ofthe tube guiding surface of the inferior tube guiding member and thedistal end of the tube guiding surface of the second superior tubecontacting member at an angle to the length of the insertion section atthe proximal end of the tube guiding surface of the inferior tubeguiding member.
 32. An elongate laryngoscope insertion section accordingto claim 30, wherein the tube guiding surface of the first superior tubecontacting member extends inferiorly towards its distal end and the tubeguiding surface of the second superior tube contacting member extendssuperiorly towards its distal end.
 33. An elongate laryngoscopeinsertion section having a proximal end and a distal end for insertioninto a patient's oral cavity in use, the insertion section comprising atube guide for removably retaining an endotracheal tube and guiding aretained endotracheal tube towards a patient's larynx, the tube guidecomprising a plurality of tube guiding members having tube guidingsurfaces which are arranged to contact and thereby guide the inferior orsuperior surface of a retained endotracheal tube, the plurality of tubeguiding members comprising at least an inferior tube guiding memberhaving a tube guiding surface on a superior side thereof for contactingand thereby guiding the inferior surface of a retained endotrachealtube, and a first superior tube guiding member having a tube guidingsurface on an inferior side thereof for contacting and thereby guidingthe superior surface of a retained endotracheal tube, wherein at least aportion of the tube guiding surface of the inferior tube guiding memberis proximal of the tube guiding surface of the first superior tubeguiding member.
 34. An elongate laryngoscope insertion section accordingto claim 33, wherein the tube guiding surface of the inferior tubeguiding member is entirely proximal of the tube guiding surface of thefirst superior tube guiding member.
 35. An elongate laryngoscopeinsertion section according to claim 33, wherein the tube guide furthercomprises a second superior tube guiding member which has a tube guidingsurface on an inferior side thereof for contacting and thereby guidingthe superior surface of a retained endotracheal tube, wherein the secondsuperior tube guiding member is proximal of the first superior tubeguiding member and the tube guiding surfaces of the first and secondsuperior tube guiding members are spaced apart, wherein the tube guidingsurface of the second superior tube guiding member is spaced apart fromand proximal of the proximal end of the tube guiding surface of theinferior tube guiding member, such that an endotracheal tube can beintroduced into the tube guide between the proximal end of the tubeguiding surface of the inferior tube guiding member and distal end ofthe tube guiding surface of the second superior tube contacting memberat an angle to the length of the insertion section at the proximal endof the tube guiding surface of the inferior tube guiding member.
 36. Anelongate laryngoscope insertion section having a proximal end and adistal end for insertion into a patient's oral cavity in use, theinsertion section comprising a tube guide for removably retaining anendotracheal tube and guiding a retained endotracheal tube towards apatient's larynx, the tube guide comprising a plurality of tube guidingmembers having tube guiding surfaces which are arranged to contact andthereby guide the inferior or superior surface of a retainedendotracheal tube, the plurality of tube guiding members comprising atleast an inferior tube guiding member having a tube guiding surface on asuperior side thereof for contacting and thereby guiding the inferiorsurface of a retained endotracheal tube, and a first superior tubeguiding member at the distal end of the tube guide having a tube guidingsurface on an inferior side thereof for contacting and thereby guidingthe superior surface of a retained endotracheal tube, wherein the tubeguide is arranged so that, for endotracheal tubes of a range of externaldiameters, a retained endotracheal tube will be continuously curved atleast from where a retained endotracheal tube extends through apatient's teeth when the insertion section is inserted fully into apatient to the first superior tube guiding member.
 37. An elongatelaryngoscope insertion section according to claim 36, wherein the tubeguide is arranged to retain the endotracheal tube with a substantiallyconstant radius of curvature.
 38. An elongate laryngoscope insertionsection according to claim 36, wherein the tube guide is arranged toretain the endotracheal tube under flexural tension from the mostproximal location where the tube guide contacts the superior surface ofa retained endotracheal tube to the most distal location where the tubeguide contacts the superior surface of a retained endotracheal tube. 39.An elongate laryngoscope insertion section according to claim 36,wherein the tube guide also contacts the inferior surface of a retainedendotracheal tube intermediate the most proximal and most distallocations where the tube guide contacts the superior surface of aretained endotracheal tube, such that a retained endotracheal tubeexerts a superior force on the tube guide at the most proximal and mostdistal locations where the tube guide contacts the superior surface of aretained endotracheal tube and an inferior force at the said locationwhere the tube guide contacts the inferior surface of a retainedendotracheal tube.
 40. An elongate laryngoscope insertion sectionaccording to claim 39 wherein the tube guide opens laterally tofacilitate the removal of a retained endotracheal tube in situ within apatient.
 41. An elongate laryngoscope insertion section having aproximal end and a distal end for insertion into a patient's oral cavityin use, the insertion section comprising a tube guide for removablyretaining an endotracheal tube and guiding a retained endotracheal tubetowards a patient's larynx and an elongate member, wherein the tubeguide comprises a plurality of tube guiding members which extendlaterally of the elongate member and have tube guiding surfaces whichare arranged to contact and thereby guide the inferior or superiorsurface of a retained endotracheal tube, the plurality of tube guidingmembers comprising at least an inferior tube guiding member having atube guiding surface on a superior side thereof for contacting andthereby guiding the inferior surface of a retained endotracheal tube,and a first superior tube guiding member having a tube guiding surfaceon an inferior side thereof for contacting and thereby guiding thesuperior surface of a retained endotracheal tube, wherein, at least onelocation along the length of the insertion section, the thickness of theelongate member is less than the thickness of the adjacent tube guide.42. An elongate laryngoscope insertion section according to claim 41,wherein the insertion section is configured such that, at the said atleast one location, the thickness of the elongate member is less thanthe thickness of the adjacent tube guide plus the external diameter of aretained endotracheal tube having the largest external diameter in theoperating range of endotracheal tube sizes.
 43. An elongate laryngoscopeinsertion section according to claim 41, wherein at least one locationwhere the tube guide comprises a superior tube guiding member, thesuperior tube guiding member extends further in a superior directionthan the elongate member, adjacent to the superior tube guiding member.44. An elongate laryngoscope insertion section according to claim 41,wherein at least one location where the tube guide comprises an inferiortube guiding member, the inferior tube guiding member extends further inan inferior direction than the elongate member, adjacent to the inferiortube guiding member.
 45. An elongate laryngoscope insertion sectionaccording to claim 41, wherein, at least one location proximal of thetube guiding surface of the first superior tube guiding member, theinsertion section is arranged such that a retained endotracheal tube atthe upper end of an operating range of endotracheal tube sizes has bothits inferior and superior surfaces left exposed in use.
 46. An elongatelaryngoscope insertion section according to claim 41, wherein, at leastone location proximal of the tube guiding surface of the first superiortube guiding member, the insertion section is arranged such that aretained endotracheal tube at the upper end of an operating range ofendotracheal tube sizes extends inferiorly and superiorly of an adjacentsection of elongate member.
 47. An elongate laryngoscope insertionsection according to claim 41, wherein, at least one location proximalof the tube guiding surface of the first superior tube guiding member,the thickness of the insertion section is less than three-quarters ofthe diameter of the largest external diameter endotracheal tube in anoperating range of endotracheal tube sizes.
 48. An elongate laryngoscopeinsertion section having a proximal end and a distal end for insertioninto a patient's oral cavity in use, the insertion section comprising atube guide for removably retaining an endotracheal tube and guiding aretained endotracheal tube towards a patient's larynx and an elongatemember, wherein the tube guide comprises a plurality of tube guidingmembers which extend laterally of the elongate member having tubeguiding surfaces which are arranged to contact and thereby guide theinferior or superior surface of a retained endotracheal tube, theplurality of tube guiding members comprising at least an inferior tubeguiding member having a tube guiding surface on a superior side thereoffor contacting and thereby guiding the inferior surface of a retainedendotracheal tube, and a first superior tube guiding member having atube guiding surface on an inferior side thereof for contacting andthereby guiding the superior surface of a retained endotracheal tube,wherein either or both (i) the inferior tube guiding member extendsfurther in an inferior direction than the elongate member adjacent tothe inferior tube guiding member or (ii) the superior tube guidingmember extends further in a superior direction than the elongate memberadjacent to the superior tube guiding member.
 49. An elongatelaryngoscope insertion section having a proximal end and a distal endfor insertion into a patient's oral cavity in use, the insertion sectioncomprising a tube guide for removably retaining an endotracheal tube andguiding a retained endotracheal tube towards a patient's larynx, whereinthe tube guide is adapted to retain endotracheal tubes with a range ofexternal diameters within an operating range of endotracheal tubeexternal diameters, under flexural tension.
 50. An elongate laryngoscopeinsertion section according to claim 49, wherein the tube guide isarranged to retain an endotracheal tube under flexural tension from themost proximal location where the tube guide contacts the superiorsurface of a retained endotracheal tube to the most distal locationwhere the tube guide contacts the superior surface of a retainedendotracheal tube.
 51. An elongate laryngoscope insertion sectionaccording to claim 50 wherein the tube guide also contacts the inferiorsurface of a retained endotracheal tube intermediate the most proximaland most distal locations where the tube guide contacts the superiorsurface of a retained endotracheal tube, such that a retainedendotracheal tube exerts a superior force on the tube guide at the mostproximal and most distal locations where the tube guide contacts thesuperior surface of a retained endotracheal tube and an inferior forceat the said location where the tube guide contacts the inferior surfaceof a retained endotracheal tube.
 52. An elongate laryngoscope insertionsection according to claim 48, wherein the tube guide is arranged suchthat a retained endotracheal tube can be removed laterally from the tubeguide.
 53. An elongate laryngoscope insertion section according to claim48, wherein the insertion section is arranged such that a retainedendotracheal tube remains exposed along an entire lateral side.
 54. Anelongate laryngoscope insertion section according to claim 49, whereinthe tube guide comprises a plurality of tube guiding members having tubeguiding surfaces which are arranged to contact and thereby guide theinferior or superior surface of a retained endotracheal tube, theplurality of tube guiding members comprising at least an inferior tubeguiding member having a tube guiding surface on a superior side thereoffor contacting and thereby guiding the inferior surface of a retainedendotracheal tube, a first superior tube guiding member having a tubeguiding surface on an inferior side thereof for contacting and therebyguiding the superior surface of a retained endotracheal tube, and asecond superior tube guiding member located proximally of the firstsuperior tube guiding member and having a tube guiding surface on aninferior side thereof for contacting and thereby guiding the superiorsurface of a retained endotracheal tube, wherein the tube guidingsurfaces of the first and second superior tube guiding members arespaced apart, with at least a portion of the tube guiding surface of theinferior tube guiding member being proximal of the proximal end of thetube guiding surface of the first superior tube guiding member anddistal of the distal end of the tube guiding surface of the secondsuperior tube guiding member, wherein the tube guiding members arearranged to retain endotracheal tubes with a range of external diameterswithin an operating range of endotracheal tube external diameters, underflexural tension such that a retained endotracheal tube exerts a forcein a superior direction on the first and second superior tube guidingmembers applying a force in an inferior direction and a force in aninferior direction on the inferior tube guiding member.
 55. An elongatelaryngoscope insertion section according to claim 54, wherein the tubeguiding members are arranged such that, for endotracheal tubes having arange of external diameters within the operating range of endotrachealtube external diameters, a retained endotracheal tube will contact thetube guiding surface of either one of or preferably both the proximaland distal superior tube guiding members only at the distal ends of therespective tube guiding member, when a retained endotracheal tube is atrest, retained within the tube guide.
 56. An elongate laryngoscopeinsertion section according to claim 54, wherein endotracheal tubeshaving a range of external diameters within the operating range ofendotracheal tube external diameters will only contact the tube guidingsurface of the inferior tube guiding member at the proximal end of thetube guiding surface, when a retained endotracheal tube is at rest,retained within the tube guide.
 57. An elongate laryngoscope insertionsection according to claim 49, wherein the tube guide is arranged tothat a retained endotracheal tube can be removed laterally from the tubeguide.
 58. An elongate laryngoscope insertion section according to claim49, wherein the insertion section comprises an elongate member and thetube guiding members extend laterally from the elongate member.
 59. Anelongate laryngoscope insertion section according to claim 49, whereinthe range of external diameters is the entire operating range ofendotracheal tube external diameters.
 60. An elongate laryngoscopeinsertion section having a proximal end and a distal end for insertioninto a patient's oral cavity in use, the insertion section comprising atube guide for removably retaining an endotracheal tube and guiding aretained endotracheal tube towards a patient's larynx and an elongatemember, wherein the tube guide comprises a plurality of tube guidingmembers which extend laterally of the elongate member and have tubeguiding surfaces which are arranged to contact and thereby guide theinferior or superior surface of a retained endotracheal tube, theplurality of tube guiding members comprising at least an inferior tubeguiding member having a tube guiding surface on a superior side thereoffor contacting and thereby guiding the inferior surface of a retainedendotracheal tube, and a first superior tube guiding member having atube guiding surface on an inferior side thereof for contacting andthereby guiding the superior surface of a retained endotracheal tube,wherein there is at least one location, proximal of the first superiortube guiding member, where an endotracheal tube is retained in uselaterally of the elongate member with the inferior and superior sides ofthe endotracheal tube being left exposed.
 61. An elongate laryngoscopeinsertion section according to claim 60, wherein no tube guiding memberis provided at the said location.
 62. An elongate laryngoscope insertionsection according to claim 60, wherein the said location is intermediatethe first and second superior tube guiding members.
 63. An elongatelaryngoscope insertion section having a proximal end and a distal endfor insertion into a patient's oral cavity in use, the insertion sectioncomprising a tube guide for removably retaining an endotracheal tube andguiding a retained endotracheal tube towards a patient's larynx, whereinthe insertion section and tube guide are arranged to leave the inferioror superior surface of a retained endotracheal tube exposed along atleast 25% of the length of the insertion section between the mostproximal location where the insertion section contacts a retainedendotracheal tube and the most distal location where the insertionsection contacts a retained endotracheal tube.
 64. An elongatelaryngoscope insertion section according to claim 63, wherein theinferior surface of a retained endotracheal tube is left exposed alongat least 25% of the length of the insertion section between the mostproximal location where the insertion section contacts a retainedendotracheal tube and the most distal location where the insertionsection contacts a retained endotracheal tube.
 65. An elongatelaryngoscope insertion section according to claim 63, wherein theinferior surface of a retained endotracheal tube is left exposed alongat least 50% of the length of the insertion section between the mostproximal location where the insertion section contacts a retainedendotracheal tube and the most distal location where the insertionsection contacts a retained endotracheal tube.
 66. An elongatelaryngoscope insertion section according to claim 63, wherein thesuperior surface of a retained endotracheal tube is left exposed alongat least 25% of the length of the insertion section between the mostproximal location where the insertion section contacts a retainedendotracheal tube and the most distal location where the insertionsection contacts a retained endotracheal tube.
 67. An elongatelaryngoscope insertion section according to claim 63, wherein thesuperior surface of a retained endotracheal tube is left exposed alongat least 50% of the length of the insertion section between the mostproximal location where the insertion section contacts a retainedendotracheal tube and the most distal location where the insertionsection contacts a retained endotracheal tube.
 68. An elongate insertionsection according to claim 63, wherein both the inferior and superiorsurface of a retained endotracheal tube are left exposed along acontinuous region of at least 5% of the length of the insertion sectionbetween the most proximal location where the insertion section contactsa retained endotracheal tube and the most distal location where theinsertion section contacts a retained endotracheal tube.
 69. An elongateinsertion section according to claim 68, wherein the continuous regionis located close to the teeth of a patient of typical dimensions whenthe insertion section is inserted fully into a patient in use.
 70. Anelongate insertion section according to claim 63, wherein the tube guideis arranged to enable a retained endotracheal tube to be removedlaterally from the tube guide and a retained endotracheal tube isretained with its lateral side at least partially exposed along theentire length of the insertion section.
 71. An elongate insertionsection according to claim 63, wherein the insertion section comprisesan elongate member and the tube guide comprises a plurality of tubeguiding members which extend laterally of the elongate member and havetube guiding surfaces which are arranged to contact and thereby guidethe inferior or superior surface of a retained endotracheal tube, theplurality of tube guiding members comprising at least a first superiortube guiding member having a tube guiding surface on an inferior sidethereof for contacting and thereby guiding the superior surface of aretained endotracheal tube and a second superior tube guiding memberhaving a tube guiding surface on an inferior side thereof for contactingand thereby guiding the superior surface of a retained endotrachealtube, wherein the second superior tube guiding member is locatedproximally of the first superior tube guiding member and the tubeguiding surfaces of the first and second superior tube guiding membersare spaced apart, wherein the tube guiding surface of the secondsuperior tube guiding member is the most proximal location where theinsertion section contacts a retained endotracheal tube.
 72. An elongateinsertion section according to claim 71, wherein the tube guidingsurface of the first superior tube guiding member is the most distallocation where the insertion section contacts the superior side of aretained endotracheal tube and the tube guiding surface of the firstsuperior tube guiding member is the most distal location where theinsertion section contacts a retained endotracheal tube.
 73. Alaryngoscope comprising a handle, and an insertion section according toclaim
 1. 74. A laryngoscope according to claim 73, wherein the insertionsection is fixedly attached to the handle.